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Dyspepsia in Pregnancy
Aka: Dyspepsia in Pregnancy, Gastroesophageal Reflux in Pregnancy, GERD in Pregnancy
- See Also
- Dyspepsia
- Nausea in Pregnancy
- Abdominal Pain in Pregnancy
- Gastrointestinal Medications in Pregnancy
- Gastroesophageal Reflux
- Evaluation
- Avoid diagnostic testing in pregnancy
- Management: First Line Agents
- General Measures
- See Gastroesophageal Reflux
- See Gastritis
- Drink 8 glasses (8 ounces) non-caffeinated fluid daily
- Decrease provocative foods
- Decrease or eliminate Caffeine, chocolate, spicy foods
- Avoid milk products toward end of day
- Avoid fatty foods
- Tobacco Cessation
- No eating food 2-3 hours before bedtime
- Elevate head of bed to 30 degrees
- First: Antacids (may interfere with iron absorption)
- Avoid Antacids that contain Salicylates, or Sodium Bicarbonate (alka-seltzer, due to alkalosis)
- Aluminum hydroxide - Magnesium Hydroxide (Maalox)
- Calcium Carbonate (Tums)
- Next: Gastric mucosa protection or skip to H2 Blocker
- Sucralfate 1 gram orally three times daily (not effective in GERD)
- Next: H2 Blocking Agents (Avoid Axid or Nizatidine)
- Ranitidine (Zantac) 150 mg orally twice daily
- Preferred H2 Blocker in pregnancy
- Cimetidine (Tagamet) 400 mg orally twice daily or at bedtime
- Famotidine (Pepcid)
- Management: Refractory cases
- Metoclopramide (Reglan)
- Avoid Proton Pump Inhibitors (e.g. Prilosec) unless approved by a primary maternity care provider
- Class C Medication
- Unknown longterm safety (although Omeprazole is considered likely safe)
- References
- Larimore (2000) Prim Care 27(1):35-53 [PubMed]
- Winbery (2001) Obstet Gynecol Clin North Am 28(2):333 [PubMed]
- Gregory (2018) Am Fam Physician 98(9): 595-602 [PubMed]